This commentary is by Daniel Caloras, M.D., a resident of Charlestown, New Hampshire, and a former longtime resident of Springfield, Vermont. He has provided primary care medicine for residents of Vermont and New Hampshire for 30 years.
Having been in health care as a primary care physician for 30 years, I have seen some change. Much change has been for the better while some for the worse.
I am from an era when computers were not to be found in hospital hallways or office desks. Oh, I yearn for the days when I could spend five more minutes with a patient and free-text a note on a paper chart.
The crisis I would like to describe is not directly related to electronic medical records or primary versus specialty care. It is about a lack of staffing. Too few health care personnel and too many patients. A supply chain problem that existed pre-Covid and has been exacerbated post-pandemic.
We read that hospitals, home care agencies and health care facilities are understaffed and paying outrageous rates to correct staffing shortages. Nursing homes are in a similar situation. The hospital cannot take another patient; the nursing home cannot admit another resident because there are no more beds.
More often, there are plenty of beds and rooms, but not enough staff. And now home health agencies cannot see people in large geographic areas because of lack of staffing.
Recruiting from elsewhere, often through temporary staffing agencies, is not sustainable. It is expensive and not a long-term method to stem the tide of illness.
I think we knew the elderly population was growing. I wonder how much thought and effort the health care decision-makers put into correcting this health care tsunami.
More doctors, nurses, aides or therapists may help in the short term. Making it more attractive for health care professionals to pursue less desirable locations or jobs is an option. Lessening the burden of massive student loans and equalizing pay rates is a frequently discussed option.
There is a more pressing problem that many policymakers do not openly address or recognize. It is politically not correct to discuss “doing too much for too few.”
This should not be misconstrued as socialized medicine or euthanasia. As a result of increased rules, regulations and requirements to fulfil, we do more work for each individual. The goal is safer outcomes, fewer mistakes, safeguards against liability, and appropriate reimbursement for each task.
This leads to more work for each task, burnout, desire to work fewer hours, and working at full capacity — when there are still beds in the nursing home, hospital and staff — in geographic regions to see homebound people.
The illnesses are not more complex now, nor were the nurses better in the old days. The demands given to the health care provider per patient are higher. Too much documentation per case is an example of the burden.
It is worrisome that I saw many excellent, committed nurses leave home care due to their need to spend just as much time typing on a computer as seeing their patients, usually late at night after the workday.
Perhaps we can free up a nurse and improve access to care if we take away some of the tasks. Maybe it would alleviate burnout by lessening the onerous tasks that usually have nothing to do with why people go into health care.
I spend many hours typing short stories as to why people need wheelchairs, hospital beds, walkers or home health care. If I do not document these short stories, the agencies that pay for these services or items will deny them. I sign hundreds of papers weekly that have minimal to nothing to do with the well-being of the people I care for. It is required for everyone to get paid. Perhaps the time can be better spent seeing more people.
Along with my regular duties in primary care, I spent years working for a hospice in a home health care agency. I also traveled to less developed countries, providing primary care to persons less fortunate. I know we can provide great care with fewer resources. Many of our ailments can be treated with care, compassion, a simple nod, touch or an extra moment of listening. Handing someone a cane to assist in walking, or a medicine to improve a skin or joint ailment.
I challenge our government agencies, insurance and hospital administrators, and health care workers to address systems that are wasteful, not efficient, and time-constraining that lead to overburdened staff and create an environment that is incapable of caring for more people.
